Hales Group Limited - Ipswich

Hales Group Limited – Ipswich is a domiciliary care service providing personal care to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 45 people using the personal care service.

People’s experience of using this service and what we found

At the time of the inspection, the location did not provide personal care for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

Not all of the people we received feedback from felt listened to by their care workers. The manager had plans to speak with all people about their experiences and recent satisfaction surveys had been sent out. They assured us actions would be taken as a result of feedback received.

Right Care

People’s care plans were not always kept up to date to guide care workers in the care required. The management team had started to improve in this area, but this was not yet fully implemented.

Right Culture

There had recently been a change of management in the service. The management team knew where they needed to make improvements, had an action plan in place, which they were working on. All improvements had not yet been fully implemented and embedded in practice.

Improvements were needed in how risks were assessed and mitigated; this includes ensuring all risk assessments were being kept up to date. There were shortages of staff, which the service was taking action to address and limit the impact on the safety of people.

We found that care plans, risk assessment and monitoring of staff had not been kept up to date. This had been identified by the service and improvements were in the process of being implemented.

There were visits which were not being undertaken for the planned time, travel time between visits was not always provided and care workers were found to be logged in to visits to multiple people at the same time. We were assured this would be addressed to limit the risks of people not receiving the care they required.

The service had systems to monitor that people received their medicines, where required. Where shortfalls were identified actions were being taken to address them. Care workers were guided in infection control and the use of personal protective equipment (PPE). However, we received feedback that not all care workers were wearing all the PPE.

Care workers were recruited safely. There were systems in place to learn lessons when things went wrong and use them to drive improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 3 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about lack of staff, late and short visits, the lack of travel time provided between visits, safe care, governance, systems to monitor staff not being kept up to date and care plans not being reviewed to ensure they were kept up to date. In addition, there was a recent change of management in the service. Following concerns received, we had undertaken a range of actions, including contacting the service for assurances, informed the local authority commissioners and/or raised a safeguarding referral with the local authority. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hales Group Limited - Ipswich on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection of 2 October 2017, the service was rated requires improvement overall. The key questions for effective, caring and well-led were rated good and the key questions safe and responsive were rated requires improvement. At this inspection we found improvements had been made. The service is now rated good overall. Improvements had been made in people’s care records. The records now included guidance for care workers how to reduce risks and meet people’s assessed and individual needs safely.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Recruitment of care workers was ongoing to reduce the risks of missed visits. Recruitment of care workers was undertaken safely and checks were made on prospective care workers to ensure they were suitable to work in this type of service. Care workers and other staff working in the service received training and guidance to reduce the risks of avoidable harm and abuse. Where people required support with their medicines, there were systems in place to manage them safely. There were infection control systems in place to reduce the risks to people.

We received mixed views from people who used the service and relatives about the timings of their visits and not being kept informed, this affected making arrangements for their day. The registered manager was immediately responsive to this feedback and gave an undertaking to address this for those affected.

A complaints procedure was in place. People’s views about the service and the care and support they received were valued and listened to and used to drive improvement.

People continued to receive an effective service. People were supported by care workers who were trained and supported to meet their needs. People were supported to have maximum choice and control of their lives and care workers cared for them in the least restrictive way possible; the policies and systems in the service supported this practice. Systems were in place to support people with their dietary needs, where required. People were supported to have access to health professionals where needed. The service worked with other organisations involved in people’s care to provide a consistent service.

People continued to receive a caring service. People had positive relationships with their care workers. People’s dignity, privacy and independence were respected and promoted. People’s views were listened to and valued. There were systems in place to support and care for people at the end of their lives, where required.

The service continued to be well-led. There was a quality assurance system in place which supported the registered manager to identify shortfalls and address them. As a result, the quality of the service continued to improve.

At our last inspection of 25 August 2015 the service was rated Good. At this inspection we found the service was rated Requires Improvement overall, improvements were needed in people’s care records which were to guide care workers how the needs of people were met and their assessed risks were minimised.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements were needed in how the service provided guidance for care workers about how people’s needs were to be met in their individual care plans. This was also the case for the risk assessments in people’s care records which did not provide sufficient guidance for care workers about how the risks in people’s daily living were to be reduced. The service was, at the time of our inspection, receiving support from the local authority in ensuring that care plans were person centred and reflected their needs and preferences. This was not yet fully implemented.

There were systems in place intended to reduce the risks of people being abused. Care workers were trained in safeguarding and understood their roles and responsibilities in reporting concerns.

There were systems in place to make sure that there were enough care workers to cover people’s planned care visits. Robust recruitment procedures were in place.

Where people required support with their medicines, this was done safely. There were systems in place to identify any shortfalls and actions were taken to reduce the risks relating to people’s medicines.

Care workers were trained and supported to meet people’s needs.

The service understood the principles of the Mental Capacity Act 2015 and people were supported to have maximum choice and control of their lives and care workers cared for them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems were in place to support people to eat and drink enough, where they required support.

People were supported to have access to health professionals, where needed.

Care workers had good relationships with people who used the service. Care workers spoke about people in a compassionate manner and understood why it was important to respect their rights to privacy, independence and dignity. People’s views and preferences were listened to and acted on.

A complaints procedure was in place and complaints were acted upon and used to improve the service.

The service has an open and empowering culture and quality assurance systems supported the management to identify shortfalls and address them promptly. Systems were in place to learn from incidents and issues and use them to improve the service. As a result the quality of the service continued to improve.